Source: medicalxpress.com
Author: University of North Carolina at Chapel Hill School of Medicine

University of North Carolina Lineberger Comprehensive Cancer Center researchers reported that reducing the intensity of radiation treatment for patients with human papillomavirus-associated head and neck cancer produced a promising two-year progression-free survival rate and resulted in fewer side effects.

The findings, published in the Journal of Clinical Oncology, were drawn from a phase II clinical trial that included 114 patients with HPV-linked head and neck cancer and a limited smoking history. The researchers reported that they saw a similar progression free survival rate, and that patients experienced fewer long-term side effects in the study compared with patients who received standard intensity treatment in previous studies.

“A simple de-intensification strategy of reducing radiation and chemotherapy appears to be as effective at cancer control as the standard seven-week regimen,” said UNC Lineberger’s Bhishamjit S. Chera, MD, associate professor in the UNC School of Medicine Department of Radiation Oncology. “Furthermore, there were fewer toxicities.”

For the trial, patients received six weeks of treatment, including a reduced intensity of radiation therapy of 60 Gray with weekly low-dose chemotherapy of cisplatin. The standard of care regimen is seven weeks of treatment 70 Gray and high-dose chemotherapy.

The main outcome that the researchers were studying was two-year progression-free survival. On the reduced regimen, researchers found that the two-year progression free survival was 86 percent, compared to a two-year progression free survival reported from other studies using standard treatment doses of 87 percent.

Chera said the major long-term side effects of radiation treatment are related to swallowing and dry mouth. Previous studies have shown the majority of patients treated with standard intensity chemoradiotherapy require a temporary feeding tube and some have significant long-term swallowing dysfunction.

Notably, in this study, patients reported that their swallowing returned to baseline after de-intensified treatment, and only 34 percent required a temporary feeding tube.

The results need to be validated in larger, randomized clinical trials, Chera said, and studies are ongoing to investigate this.

He added that while this study included patients with a limited smoking history, other current studies include patients with more extensive smoking histories.

Chera said that researchers want to continue to improve two-year progression free response rates while achieving better side effect results. They want to do that by identifying additional biomarkers to drive precision medicine strategies.

Although traditional clinical risk help clinicians predict outcomes and select patients for clinical trials of de-intensified treatments, Chera said that these risk factors are imprecise. He and his colleagues are currently evaluating additional novel biomarkers that they believe could be used to better predict a patient’s prognosis and outline a course of treatment.

Specifically, they have shown in a previous study how levels of circulating HPV DNA in the blood, and how quickly patients clear this from the blood, were linked to outcomes.

A study of the perceptions of health care professionals involved in the care of patients with head and neck cancer undergoing radiation therapy regarding optimal feeding tube practices showed no consensus; however, feeding tube placement was considered important for some patients. This study was published in JPEN Journal of Parenteral Enteral Nutrition.

Patients with head and neck cancer frequently undergo intensive treatment that may include a long course of radiation therapy in addition to surgery and chemotherapy. Treatment-related toxicity can involve severe dysphagia and mucositis, as well as reduced food intake and unintentional weight loss; these clinical sequelae can also lead to treatment delays and an increased risk of hospitalization.

Clinical practice guidelines include recommendations for early enteral feeding in patients with stage IV disease or hypopharyngeal tumors who are receiving chemoradiotherapy, as well as other patients with head and neck cancer, “depending on factors including their treatment, nutrition status, dysphagia, social support, and food intake.” However, there is no conclusive evidence as to which of the most commonly used feeding tubes — a nasogastric tube (NGT) placed when additional nutritional support is needed or a prophylactic gastrostomy tube (PGT) placed before radiation therapy — is preferable.

In this qualitative study, in-depth interviews were conducted with interdisciplinary health care professionals from 4 radiation therapy departments (2 in the United States and 2 in Australia) to evaluate their perspectives and experiences regarding feeding tube practices in patients with head and neck cancer.

Of the 46 health care professionals participating in the study, 26% were nurses, 37% were radiation oncologists, 24% dieticians, and 13% were speech pathologists.

One of the interesting findings from this study was the lack of a feeding tube protocol in place at all 4 radiation oncology departments, with decisions regarding feeding tube placement typically made by staff specialists on a case-by-case basis.

When use of a feeding tube was deemed appropriate, healthcare professionals at 3 of the radiation oncology departments favored the use of PGT, whereas NGT was preferred at the remaining department.

Patient-related factors considered to be important in decision making regarding feeding tube placement included planned treatment, tumor characteristics, nutrition and swallow status, risk of tube dependence, psychosocial status, and patient preferences. Other factors cited as potentially bearing on decisions related to feeding tubes were access to a dietician and a speech pathologist, as well as interdisciplinary collaboration, and the infrastructure to support timely feeding tube placements and intravenous fluids.

Because two-thirds of oral cancer diagnoses are made when the cancer is advanced, treating it usually requires complex surgeries, followed by reconstructive procedures that are necessary because tissue has been removed from the patient’s face.

A University of Oklahoma researcher is developing computer technology and a new medical device that he hopes can detect oral cancer at an early stage, when the survival rate is much higher. Javier Jo, Ph.D., is a professor with the School of Electrical and Computer Engineering on OU’s Norman campus, and a member of Stephenson Cancer Center at OU Medicine. His expertise in applying engineering concepts to solve a medical problem earned him a $2.5 million grant from the National Cancer Institute.

Jo’s research involves creating a hand-held endoscope to look for precancerous and cancerous lesions of the mouth, and “training” it to recognize patterns and signatures of those lesions with more accuracy and at an earlier stage.

“When oral cancer is diagnosed early, treating the patient is much more effective and a lot less invasive,” he said. “The survival rate and quality of life of the patient is fairly high if the cancer is detected early.”

Jo’s technology aims to address two problems in oral cancer detection. A person’s general dentist is usually the first health provider to examine the tissue inside the mouth and search for lesions based on look and feel. However, it’s difficult to distinguish a benign lesion from a cancerous or precancerous lesion, Jo said. In addition, dentists have varying degrees of experience in oral cancer screening.

If a dentist discovers a suspicious lesion, the patient will usually be referred to an oral pathologist, who may decide to do a tissue biopsy. However, because some lesions are quite large, the pathologist has to decide from which area to take the biopsy sample. Unfortunately, the pathologist may take a sample from a non-cancerous portion of the lesion, yet another area is cancerous, Jo said.

“Those are two main barriers to detecting oral cancer early,” Jo said. “What’s missing is an objective and quantitative tool to provide more precise information about the presence of malignant vs. benign lesions.”

Jo is developing fluorescence imaging endoscopes and combining them with artificial intelligence technologies. When he shines light of a specific color into the tissues of a person’s mouth, the molecules in those tissues respond by emitting light of their own, known as fluorescence. Because cancer cells divide very quickly, Jo is looking for changes in the fluorescence characteristics of specific molecules associated with increased cell activity – a hallmark of cancer cells.

At the current stage of his research, Jo’s team is engineering the endoscopes, which will be sent to several clinical centers where patients with suspicious lesions will be imaged before having a biopsy to confirm whether oral cancer is present. This multicenter study will provide data to develop artificial intelligence algorithms that aim to distinguish between benign, precancerous and cancerous oral lesions.

“Once we have a computer algorithm that can discern different types of lesions, we can put that algorithm into the endoscope and test it on a larger group of patients to see if it works with enough accuracy to be clinically useful,” Jo said.

Jo’s aim is that the technology will first be used in the dentist’s office for a more accurate determination of whether a patient needs to be referred to an oral pathologist. He also envisions an oral pathologist using the tool to determine which area of the lesion needs to biopsied.

Robert Mannel, M.D., Stephenson Cancer Center director and Rainbolt Family Chair in Cancer, said Jo’s research has the potential to dramatically increase the number of oral cancer patients who are diagnosed at an earlier stage.

“We are excited by the prospects of Dr. Jo’s innovative research,” Mannel said. “Not only does it point to a promising avenue of improving patient outcomes through earlier cancer detection, it also underscores the close collaboration between Stephenson Cancer Center researchers at the OU Health Sciences Center and OU Norman campuses.”

Treatment delayed longer than 2 months from the time of diagnosis negatively affected survival and increased recurrence among patients with head and neck squamous cell carcinoma (HNSCC), a retrospective study found.

Looking at a group of 956 patients treated at a single urban academic center, those with a time to treatment initiation (TTI) longer than 60 days were significantly more likely to die from their disease (odds ratio [OR] 1.69, 95% CI 1.32-2.18) and have disease recurrence (OR 1.77, 95% CI 1.07-2.93) compared to those treated within this timeframe, reported Vikas Mehta, MD, MPH, of Montefiore Medical Center in New York City, and colleagues.

As described in JAMA Otolaryngology–Head & Neck Surgery, the 5-year overall survival for patients dropped from 64.5% to 47.0% when the TTI stretched beyond 60 days.

“If I invented a drug that could give a 20% improved survival in head and neck cancer patients, a disease where survival has not changed for many years, I would probably be getting handed a large amount of funding,” Mehta told MedPage Today.

“This study is just as important,” he continued. “Getting patients to treatment in a timely manner can independently improve survival.”

Initial diagnoses at the treatment institution decreased the odds of TTI delay by almost 50% (OR 0.53, 95% CI 0.37-0.76). However, patients with Medicaid as compared with commercial insurance were significantly more likely to have treatment delays (OR 2.17, 95% CI 1.28-3.66). As were African-American patients and those with a body mass index (BMI) of 18.5.

“Unlike studies that look at things from a national perspective, this study shows that not all populations are created equal,” Mehta said. “For some populations the issue with delays is that the population covers a large geographical area where it is hard for people to travel. In our population, the big issue is socioeconomic and comorbidities.”

In an editorial that accompanied the article, Evan Graboyes, MD, and Chanita Hughes-Halbert, PhD, of the Medical University of South Carolina, wrote that these new data add to an existing body of evidence about delays in HNSCC and the call to “recognize the devastating oncologic consequences of treatment delays.”

Specifically, Graboyes and Hughes-Halbert pointed out that identification of missed appointments (21.2%), extensive pretreatment evaluation (21.2%), and treatment refusal (13.6%) as the three most common reasons for delay are “key to advancing our understanding of HNSCC care delivery.”

However, they cautioned that these results should be seen only as hypothesis generating.

“It is imperative that the science move beyond continuing to characterize the frequency and oncologic consequences of treatment delays and instead focus on identifying and understanding the barriers to timely care at the patient, healthcare provider, and system levels so that we may develop and test novel interventions specifically targeted at these barriers,” Graboyes and Hughes-Halbert wrote.

Mehta agreed with this conclusion, telling MedPage Today that he and colleagues at his cancer center are now beginning work to measure these outcomes in real time.

“We want to have the ability to measure month to month and patient by patient how we are performing in terms of when we diagnose and when we first treat,” Mehta said. “By looking at that benchmark we can begin planning interventions in an organized, quality-improvement-based fashion. Collaborating with other institutions will be key.”

Study Details
All 956 participants in the retrospective study had primary HNSCC diagnosed from February 2005 to July 2017 and were identified using the Montefiore Medical Center Cancer Registry.

The median TTI among all patients was 40 days. About one-fifth of patients were identified as having a TTI of longer than 60 days and considered to have delayed treatment.

Researchers from Charité — Universitätsmedizin Berlin and the German Cancer Consortium (DKTK) have successfully solved a longstanding problem in the diagnosis of head and neck cancers. Working alongside colleagues from Technische Universität (TU) Berlin, the researchers used artificial intelligence to develop a new classification method which identifies the primary origins of cancerous tissue based on chemical DNA changes. The potential for introduction into routine medical practice is currently being tested. Results from this research have been published in Science Translational Medicine.

Every year, more than 17,000 people in Germany are diagnosed with head and neck cancers. These include cancers of the oral cavity, larynx and nose, but can also affect other areas of the head and neck. Some head and neck cancer patients will also develop lung cancer. “In the large majority of cases, it is impossible to determine whether these represent pulmonary metastases of the patient’s head and neck cancer or a second primary cancer, i.e. primary lung cancer,” explains Prof. Dr. Frederick Klauschen of Charité’s Institute of Pathology, who co-led the study alongside Prof. Dr. David Capper of Charité’s Department of Neuropathology. “This distinction is hugely important in the treatment of people affected by these cancers,” emphasizes Prof. Klauschen, adding: “While surgery may provide a cure in patients with localized lung cancers, patients with metastatic head and neck cancers fare significantly worse in terms of survival and will require treatments such as chemoradiotherapy.”

When trying to distinguish between metastases and a second primary tumor, pathologists will usually use established techniques such as analyzing the cancer’s microstructure and detecting characteristic proteins in the tissue. However, due to the marked similarities between head and neck cancers and lung cancers in this regard, these tests are usually inconclusive. “In order to solve this problem, we tested tissue samples for a specific chemical alteration known as DNA methylation,” explains Prof. Capper who, like Prof. Klauschen, is a Scientific Member of the DKTK in Berlin. He adds: “We know from earlier studies that DNA methylation patterns in cancer cells are highly dependent on the organ in which the cancer originated.”

Working with Prof. Dr. Klaus-Robert Müller, Professor for Machine Learning at TU Berlin, the research group employed artificial intelligence-based methods to render this information useful in practice. The researchers used DNA methylation data from several hundred head and neck and lung cancers in order to train a deep neural network to distinguish between the two types of cancer. “Our neural network is now able to distinguish between lung cancers and head and neck cancer metastases in the majority of cases, achieving an accuracy of over 99 percent,” emphasizes Prof. Klauschen. He continues: “To ensure that patients with head and neck cancers and additional lung cancers will benefit from the results of our study as quickly as possible, we are currently in the process of testing the implementation of this diagnostic method in routine practice. This will include a prospective validation study to ensure that the new method can be made available to all affected patients.”

Having worked alongside the researchers from Charité, the Director of the Berlin Center for Machine Learning (BZML), Prof. Müller, is similarly delighted at their results: “Artificial intelligence is playing an increasingly important role, not only in our daily lives and in industry, but also in natural sciences and medical research. The use of artificial intelligence is, however, particularly complex within the medical field; this is why, until now, research findings have only rarely delivered direct benefits for patients. This could now be about to change.”

The United States could be approaching a state of herd immunity against human papillomavirus (HPV), a virus linked to several cancers.

Oral HPV infections declined by 37% among unvaccinated 18- to 59-year-old men between 2009 and 2016, according to a Sept. 10 report in the Journal of the American Medical Association.

That included a decline in infections of HPV16, the strain found in more than 9 out of 10 cases of head and neck cancer related to the virus, said senior researcher Dr. Maura Gillison, a professor of medicine at MD Anderson Cancer Center in Houston.

Researchers say men are benefitting from increased HPV vaccination rates among American women, who receive the vaccine to prevent virus-caused cervical cancer.

“In contrast to cervical cancers, we have no means by which to screen for HPV-positive head and neck cancers,” Gillison said. “The vaccine is our best hope for prevention.”

HPV vaccination has been recommended for girls since 2006 and for boys since 2011. The virus has been linked to cancers of the cervix, penis, anus, mouth and throat.

Vaccination rates among boys and girls are steadily rising, according to the U.S. Centers for Disease Control and Prevention.

About half of teens were up to date on the HPV vaccine in 2017, and two-thirds of 13- to 17-year-olds had received the first dose to start the series. On average, the percentage of teens who started the HPV vaccine series rose by 5 percentage points each year between 2013 and 2017, the CDC says.

“At least 75% vaccine coverage of boys and girls would be necessary to eradicate HPV16, the HPV type that is most likely to lead to cancer development,” Gillison said.

But vaccination rates have lagged among males.

To see if males are receiving some protection from greater HVP vaccination among females, Gillison and her colleagues reviewed U.S. federal health survey data gathered between 2009 and 2016.

They found that by 2016, about 15% of women and 6% of men had received the vaccine.

Despite lower vaccination rates among males, oral HPV infections declined from 2.7% to 1.6% in men between 2009 and 2016.

Interestingly, prevention of oral HPV infections and the head and neck cancers they cause is not listed as a reason to get the vaccine, Gillison said. No clinical trials have been undertaken to show that the HPV vaccine could prevent such cancers.

The decrease in HPV infections among the unvaccinated men is consistent with a decline in genital HPV infections among unvaccinated women between 2004 and 2014, the researchers noted.

“This study demonstrates that even with suboptimal uptake of the HPV vaccine, important gains are being made in herd immunity against oral HPV types included in the vaccine,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security in Baltimore. He was not involved with the study.

“Oral HPV infection is a major factor in the development of head and neck cancer, and this vaccine has the potential to be game-changing as more individuals are vaccinated,” Adalja said.

HPV-positive head and neck cancers are the most rapidly rising cancers in the United States among men under age 60, Gillison said.

She called on doctors to use the data from this and other studies to promote HPV vaccination.

“I can guarantee that all of my patients diagnosed with HPV-positive head and neck cancer would exchange two or three shots for three months of toxic cancer therapy in a heartbeat,” she said.

“The HPV vaccine, together with the hepatitis B vaccine, are the two most important advances in the history of cancer prevention, period,” Gillison concluded.

Turning red after consuming alcohol may seem like a mere social inconvenience. Yet, behind this red complexion lies a far more serious problem. ALDH2 deficiency, more commonly known as Alcohol Flushing Syndrome or Asian Glow, is a genetic condition that interferes with the metabolism of alcohol. As a result, people with ALDH2 deficiency have increased risks of developing esophageal and head and neck cancers . Globally, this deficiency affects 540 million people — 8% of the world population. In East Asia (which includes Japan, China, and Korea), this is a much bigger problem, where 36% of the population is affected [1]. In our home, Taiwan, approximately 47% of the population carries this genetic mutation — the highest percentage in the world [2]!

Normally, ethanol is first converted to acetaldehyde (a toxic intermediate) by the enzyme alcohol dehydrogenase (ADH). A second enzyme, aldehyde dehydrogenase 2 (ALDH2), then converts toxic acetaldehyde into acetate, a compound which can be safely metabolized in the body. For people who carry wild type ALDH2*1, acetaldehyde can be broken down quickly. People with ALDH2 deficiency, however, have a point mutation which leads to the less efficient mutant ALDH2*2 [3], [4]. Enzymatic activity in ALDH2-deficient individuals can be as low as 4% compared to wild type [4], [5], [6], [7]. As a result, acetaldehyde accumulates and induces an inflammatory response that causes the skin to flush after drinking alcohol [8]. Turning red is the most obvious result of ALDH2 deficiency, but symptoms also include headaches, dizziness, hypotension, and heart palpitations [5], [9].

Acetaldehyde accumulates in ALDH2-deficient individuals. Ethanol is first converted to a toxic intermediate, acetaldehyde, by ADH, then converted to acetate by wild type ALDH2*1. The mutant form, ALDH2*2, cannot fully convert acetaldehyde into acetate, and toxic acetaldehyde accumulates as a result.

For people who are ALDH2-deficient and drink, acetaldehyde can accumulate to toxic levels. The International Agency for Research on Cancer classifies acetaldehyde associated with alcohol consumption as a Group 1 carcinogen [10]. Acetaldehyde levels over 50 μM are considered toxic and cause mutations in DNA, and studies show that the strongest effects are seen in the mouth [11], [12]. After consuming roughly 2 to 3 servings of alcohol (0.5-0.6 g alcohol/kg body weight), salivary acetaldehyde levels in ALDH2-deficient individuals reached over 100 μM, compared to normal levels of <20 μM without drinking [13], [14], [15], [16]. Because of the increased salivary acetaldehyde, people with ALDH2 deficiency are 2 to 8 times more likely to develop head and neck cancers (including oral cancer, pharyngeal cancer, laryngeal cancer, etc.), and 2 to 12 times more likely to develop esophageal cancer compared to people with normal ALDH2*1 [17-25].

Our ALDH2*1 probiotic candy significantly reduces acetaldehyde levels in simulated oral conditions. (A) The conversion of acetaldehyde to acetate by ALDH2 uses NAD+ and produces NADH. (B) Experimental setup. The candies were dissolved, the probiotic (Nissle) was lysed to release ALDH2 enzymes, and the supernatant was placed into artificial saliva. NADH concentration was measured by taking absorbance readings at 340 nm. (C) Enzymatic activity of ALDH2*1 and ALDH2*2 from the probiotic candies. A negative control of candy without Nissle was also included (gray). Under these conditions, the ALDH2*1 candies metabolized significantly more acetaldehyde compared to both the ALDH2*2 candies and the negative control. Error bars represent standard error.

To directly address the increased esophageal and head and neck cancer risks, we developed a probiotic (E. coli Nissle 1917) candy carrying recombinant human ALDH2*1 to maintain normal acetaldehyde levels in the mouths of ALDH2-deficient individuals. We tested the candy’s ability to break down acetaldehyde by measuring NADH, a byproduct of acetaldehyde metabolism. In simulated oral conditions, we observed a significant decrease in acetaldehyde levels when we added the contents of our ALDH2*1 candy (compared to the mutant ALDH2*2 or control candy). Through mathematical modeling, we also determined the exact amount of recombinant ALDH2*1 needed in each piece of candy. Our modeling shows that if a consumer eats our candy while drinking, the released ALDH2*1 will be able to combat the high salivary acetaldehyde levels and match the normally low levels found in wild type individuals.

Our final product, an ALDH2*1 probiotic candy!

Nearly half of Taiwan’s population is ALDH2 deficient. To combat the increased cancer risks associated with this deficiency, we developed and tested a method to regulate acetaldehyde levels in ALDH2-deficient individuals.

The TAS_Taipei iGEM Team have produced a full research article detailing their project. You can access that article here.

Note:Please note that the team’s full research article has not been peer-reviewed.

Light therapy appeared to be an effective intervention for the prevention of painful oral mucositis associated with cancer treatment, according to results of a systematic review and meta-analysis.

“Many patients [with cancer] can now benefit from this treatment,” Praveen R. Arany, DDS, PhD, assistant professor of oral biology and biomedical engineering at University at Buffalo School of Dental Medicine, said in a press release. “The staggering breadth of clinical application for photobiomodulation therapy, or light therapy, has been both a boon and a bane for the field. Several anecdotal clinical reports have been plagued with questionable rationales and inconsistent outcomes, often relegating this treatment to a pseudoscience.”

Arany and colleagues systematically reviewed published literature in an effort to update the evidence-based clinical practice guidelines on the use of photobiomodulation — including laser and other light therapies — for the prevention and treatment of oral mucositis among patients with cancer. Patients underwent treatment with hematopoietic stem cell transplantation, head and neck radiotherapy, or head and neck radiotherapy plus chemotherapy.

Study findings supported the use of photobiomodulation therapy for the prevention of oral mucositis among certain patients with cancer.

HemOnc Today spoke with Arany about the research and the clinical implications of the findings.

Question: What prompted this research?
Answer: The current forms of cancer treatment are all essential to reduce cancer burden. Unfortunately, complications from these treatments include oral mucositis pain. This not only has a significant impact on quality of life, but also often requires treatment with opioids. The pain and discomfort can be so severe it may even interrupt treatment, which can be lethal. There are no targeted treatments for this condition. We commonly use a mouthwash, which provides relief from symptoms. In contrast to this, there is increasing evidence for the use of light therapy based on precise biological mechanisms.

Q: Can you explain the rationale for this therapy?
A: This treatment has been shown to modulate various biological signaling pathways in cells that results in a positive response, such as alleviation of pain or inflammation. In addition, our lab uncovered a mechanism involving direct activation of a growth factor capable of stimulating wound healing and tissue regeneration. A combination of these responses is responsible for therapeutic benefit in oral mucositis pain.

Q: How did you conduct the study?
A: For the systematic review and meta-analysis, we looked at previously published human clinical studies that focused on how light therapy was used for the prevention of oral mucositis pain. We used the evidence from all studies to establish guidelines, re-analyzing data from each study to develop the final recommendations.

Q: What did you find?
A: There is significant evidence to use photobiomodulation therapy, or light therapy, for the prevention and treatment of oral mucositis pain when patients undergo radiation plus chemotherapy, as well as radiation alone and HSCT. In some instances, photobiomodulation therapy also was used as a preventive measure before and during cancer treatments to reduce the risk for oral mucositis pain.

Q: What will subsequent research entail?
A: The major finding was this treatment is effective. However, most of the studies that we reviewed were performed outside of the United States — including in Brazil, Europe and Asia. It is necessary to conduct studies in the U.S. in a more controlled manner with new devices available. This will be the primary focus of future human clinical research. Preliminary research studies have addressed potential effects of this treatment on tumors and the data are very promising, noting few — if any — deleterious side effects.

Q: Is there anything else that you would like to mention?
A: This is a noninvasive and nonpharmacological approach. This is especially important in the context of opioids in cancer care. Clearly, opioids are effective drugs that have an essential role in pain management. Unfortunately, they have a high threshold for abuse. The use of photobiomodulation therapy can reduce this incidence because patients will not be exposed to opioids. Besides mucositis, photobiomodulation therapy also has been noted to reduce hair loss, depression and fatigue — all key concerns for patients undergoing cancer treatment. Hopefully, we soon will see other published reports that will lead to improved cancer care using this simple but potent new technology. – by Jennifer Southall

Despite a recent dental visit, more individuals of a minority race/ethnicity and low socioeconomic status report not receiving an oral cancer screening exam, according to a study published online Aug. 20 in the American Journal of Preventive Medicine.

Avni Gupta, B.D.S., M.P.H., from Brigham and Women’s Hospital in Boston, and colleagues analyzed data from individuals aged 30 years or older who received a dental visit in the previous two years. The likelihood of intraoral and extraoral cancer screening exams was assessed, while adjusting for age, sex, race/ethnicity, education, marital status, poverty income ratio, health insurance, tobacco smoking, and alcohol consumption.

Overall, 37.6 and 31.3 percent of individuals reported receiving an intraoral and extraoral cancer screening exam, respectively. The researchers found that the likelihood of having received intraoral or extraoral cancer screening exams was lower for minority racial/ethnic groups versus white, non-Hispanics; those with less education versus more education; those who were uninsured and Medicaid-insured versus privately insured; and low-income versus high-income participants. The likelihood of being screened did not differ based on smoking status, while the likelihood was increased for alcohol consumers. Less-educated and low-income subgroups were less likely to be screened.

A combination of palbociclib and cetuximab demonstrated substantial antitumor activity among patients with platinum- or cetuximab-resistant HPV-unrelated head and neck squamous cell carcinoma, according to results of a multigroup phase 2 trial published in The Lancet Oncology.

“Currently, effective therapeutic options for patients with cetuximab-resistant HNSCC are few. Traditional chemotherapy has marginal activity, with 6% of patients or fewer achieving a tumor response,” Douglas R. Adkins, MD, professor in the oncology division of the department of medicine at Washington University School of Medicine in St. Louis, and colleagues wrote. “The most effective therapy for these patients might be pembrolizumab [Keytruda, Merck] or nivolumab [Opdivo, Bristol-Myers Squibb], which have resulted in responses in 11% to 16% of patients and median OS of 6.9 months to 8 months. Novel treatment strategies are needed for patients with recurrent or metastatic HNSCC.”

The combination of the cyclin-dependent kinase (CDK) 4/6 inhibitor palbociclib (Ibrance, Pfizer) and epidermal growth factor receptor inhibitor cetuximab (Erbitux, Eli Lilly) appeared safe and tolerable in the phase 1 portion of the multicenter trial, conducted across eight U.S. university sites.

For phase 2, Adkins and colleagues divided 62 patients with HPV-unrelated HNSCC (median age, 66 years; interquartile range [IQR], 58-70; 71% men) into two groups: those who were platinum-resistant (group 1; n = 30) and those who were resistant to cetuximab (group 2; n = 32). Primary tumor sites included the oral cavity (42%) and larynx (29%), and 81% of patients had received one or two prior lines of treatment for metastatic or recurrent disease.

All participants received oral palbociclib (125 mg daily on days 1-21) and IV cetuximab (400 mg/m2 on day 1 of cycle one, followed by 250 mg/m2 once weekly) in 28-day cycles. Objective response, defined as complete and partial responses per RECIST 1.1 criteria, served as the primary endpoint.

Researchers followed patients in group 1 for a median 5.4 months (IQR, 4.4-12.1) and those in group 2 for a median 5.5 months (IQR, 4.3-8.3).

In each group, only one patient with a tumor response previously had received immunotherapy.

The most prevalent grade 3 to grade 4 adverse event associated with palbociclib was neutropenia, which occurred in 34% (n = 21) of all patients. The researchers did not document any treatment-related deaths.

The researchers cited various limitations to their study, including its single-group design, and noted that the results will need to be confirmed in a controlled trial with a larger sample size. They acknowledged that immunotherapy might have affected OS outcomes, and that the study design did not permit the evaluation of whether palbocilib’s antitumor activity occurred directly or by reversal of primary cetuximab resistance.

These data suggest a need for further study of palbociclib in patients with recurring or metastatic HNSCC, according to a related editorial by Garth W. Strohbehn, MD, hematology/oncology fellow at University of Chicago, and Everett E. Vokes, MD, professor of medicine and radiation oncology physician-in-chief at University of Chicago Medicine.

“However, we should be circumspect about the prospect of CDK 4/6 inhibitors as standardized, cost-effective therapies in recurrent and metastatic HNSCC,” the authors wrote. “Bringing this class of drugs to head and neck oncology clinics, as either monotherapies or immunotherapy partners, will require appropriately controlled studies linked to biomarker evaluation with both survival and cost-effectiveness endpoints.” – by Jennifer Byrne